Advanced Brain Imaging in Traumatic Brain Injury: Helping Us Understand What We Do Not Know or What We Are Missing

(1)

1 https://kjnt.org

Mortality is an important outcome factor when dealing with severe traumatic brain injury (TBI). Aggressive management strategies implemented before and during hospitalization have been effective in decreasing the mortality rate. In addition, management guidelines for severe TBI have been published and consistently updated.^2,3) However, we currently do not have enough research that provides evidence of high enough quality (i.e., Level I) to make absolute recommendations regarding TBI. We believe this may be partially attributable to the heterogeneity of TBI.

Computed tomography (CT) scans of the brain, intracranial pressure monitoring, and neurophysiological monitoring give neurosurgeons important information to aid in deciding how to manage patients with TBI. Brain CT scans play a critical role in helping neurosurgeons visualize intracranial conditions such as hematomas, edema, and brain herniations, and determine whether and how to operate. These tools are valuable for managing TBIs, but are not sufficient for predicting or explaining functional outcomes. In addition, they rarely provide crucial information to objectively explain the symptoms of patients with mild TBIs.

TBIs are very heterogenous, and brain networks and mechanisms are complex. Closed head injuries do not solely affect the impact site but may affect all intracranial structures. For these reasons, it has been difficult to conduct quality research.

Lee conducted a discerning review article of advanced imaging in TBI, which has been published in this issue.⁴⁾ This paper covers the basic physics and clinical utility of various sequences in brain magnetic resonance imaging (MRI). The author is a radiologist, but she gives neurosurgeons a reference tool for advanced imaging techniques in TBI. Historically, mild TBIs have not received attention from neurosurgeons. Instead, psychiatrists or

paramedic personnel have taken care of patients affected by mild TBIs. Mild neuropsychiatric symptoms after head injury, including headache, dizziness, lack of attention, and insomnia, among others, have been easily overlooked. However, these symptoms cause difficulties in the social lives of affected patients. Recently, research has been published demonstrating that repetitive head injuries result in changes within the brain.^1,5,6) In the future, advanced MRI and cutting-edge imaging techniques will aid in predicting functional outcomes after a head injury and objectively explain patients' neuropsychiatric symptoms. Until then, advanced MRI can help clinicians find small lesions that are not visible in conventional radiological imaging techniques. Neurosurgeons dealing with head injuries should understand advanced Korean J Neurotrauma. 2020 Apr;16(1):1-2

https://doi.org/10.13004/kjnt.2020.16.e14 pISSN 2234-8999·eISSN 2288-2243

Editorial

Received: Apr 23, 2020 Accepted: Apr 27, 2020 Address for correspondence:

Sun-Chul Hwang

Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea.

E-mail: sunchulh@schmc.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://

creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORCID iDs Sun-Chul Hwang

https://orcid.org/0000-0001-8008-0749 Conflict of Interest

The author has no financial conflicts of interest.

Sun-Chul Hwang , Editor-in-Chief, Korean Journal of Neurotrauma

Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Advanced Brain Imaging in Traumatic Brain Injury: Helping Us Understand What We Do Not Know or What We Are Missing

► See the article “Advanced Imaging of Traumatic Brain Injury” in volume 16 on page 3.

(2)

imaging techniques, and should be concerned with patients with mild head injuries as well as severe head injuries. Evaluating and managing mild head injuries is an important future direction for neurosurgery. The first step is to understand advanced imaging of TBI.

REFERENCES

1. Bernick C, Shan G, Zetterberg H, Banks S, Mishra VR, Bekris L, et al. Longitudinal change in regional brain volumes with exposure to repetitive head impacts. Neurology 94:e232-e240, 2020

PUBMED | CROSSREF

2. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery 58:S25-S46, 2006

3. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80:6-15, 2017

4. Lee AL. Advanced imaging of traumatic brain injury. Korean J Neurotrauma 16:3-17, 2020 CROSSREF

5. Niogi SN, Luther N, Kutner K, Shetty T, McCrea HJ, Barnes R, et al. Increased sensitivity to traumatic axonal injury on postconcussion diffusion tensor imaging scans in National Football League players by using premorbid baseline scans. J Neurosurg, Forthcoming 2019

6. Patel JB, Wilson SH, Oakes TR, Santhanam P, Weaver LK. Structural and volumetric brain MRI findings in mild traumatic brain injury. AJNR Am J Neuroradiol 41:92-99, 2020

2 https://kjnt.org https://doi.org/10.13004/kjnt.2020.16.e14

Advanced Brain Imaging in TBI in the Future